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Systems change pilot in Bangladesh

The systems change workshop in Bangladesh helped identify critical leverage points for eye health.

The Systems Change approach for the implementation of 2030 In Sight is a proposal for national level implementation of the strategy. Each country has a unique set of social, economic, and political conditions, which means that the change needed in each country, and the potential levers for change, are often very different.

As IAPB has limited personnel at the local and regional levels, we are working with IAPB members who are exploring a systems leadership role while also supporting and sharing their processes with the wider community.

The Fred Hollows Foundation, an IAPB member, has taken up the mantle of systems leadership, working to adapt the 2030 In Sight strategy to the national level. Beginning in Bangladesh, a team including Fred Hollows Foundation’s global engagement and research teams, representatives from Sightsavers, and advisors from SIMFO adapted a version of the IAPB 2030 In Sight systems map, hosting an initial workshop that brought together a range of stakeholders from throughout the country’s eye care sector.

The Bangladesh Eye Health Systems Map

The intent for the map was to create a useful representation of the eye health system in Bangladesh. Building upon the “generic” eye health systems map, the Bangladesh project team was provided with training and support to adapt the map to reflect Bangladesh’s unique situation.

In the process, the Bangladesh team interviewed several eye health system stakeholders, but also drew upon their own rich understanding of the context in which they worked. These additional inputs led to several modifications, without changing the overall structure of the map.

Eye care sector systems mapping workshop

An initial workshop to unite the Bangladesh eye health sector in a dialogue centred on identifying the most critical leverage points to align their country’s eye health system with the high-level model envisioned in 2030 In Sight.

List of participating organisations (in alphabetical order)

  • Action Aid
  • BNSB Eye Hospital
  • BRAC
  • CBM
  • CDD
  • Deep Eye Care Hospital
  • Essilor
  • Government of Bangladesh
  • Grameen Health Service
  • Hellen Keller International
  • Impact Foundation Bangladesh
  • Islamia Eye Institute & Hospital
  • National Eye Care, Government of Bangladesh
  • Orbis
  • PKS Hospital, Jessore
  • UNDP
  • World Vision Bangladesh

The workshop provided a facilitated space in which participants could collectively reflect on their mental models of how the system operates. The systems map functions as an object-to-think-with. It both helps participants understand the full scope of the issue in question and also enables participants to illustrate their key points as they discuss with their peers.

While all participants should be able to see themselves and their work on the map, most should learn something new about the system and meet people with whom they have never interacted with before.

Bangladesh draft systems map from February 2022

Critical to the process was the ability for stakeholders to dive in and begin using the tool which, while far more efficient than other tools, is often daunting at first glance. A step-by-step, layer-by-layer walkthrough of the map was presented by our SIMFO advisor via Zoom, while representatives of local INGOs, armed with an advanced look and walkthrough of the map, were positioned at each table to answer questions.

Once participants were oriented, we proceeded with the exercises, which asked participants to use the map to identify variables:

  • On which they and their organisations were working
  • That matched the metrics by which they measure progress
  • That represented the strongest barriers to achieve the vision
  • That represented the most promising leverage points to shift the system

This workshop was a first step, to be followed up with subsequent engagements with additional organisations who are eye health stakeholders, whether they know it or not: organised labour, commerce, education, and sustainable development.

Connecting to a community of practice

We envisioned the team in Bangladesh to be one of many in a global cohort of systems change initiatives, a community of practice that will accelerate innovation through their connection to one another, supported with critical resources and training provided by the IAPB secretariat. To that end, the map was used at our 2022 annual gathering,  hosted online and in-person in Dubai, the United Arab Emirates. This series of sessions began the process of establishing a common language to be used in any national context.